Picking up the bill - improving health-care utilisation in the Democratic Republic of Congo through user fee subsidisation: a before and after study

Hdl Handle:
http://hdl.handle.net/10144/336619
Title:
Picking up the bill - improving health-care utilisation in the Democratic Republic of Congo through user fee subsidisation: a before and after study
Authors:
Maini, R; Van den Bergh, R; van Griensven, J; Tayler-Smith, K; Ousley, J; Carter, D; Mhatre, S; Ho, L; Zachariah, R
Journal:
BMC Health Services Research
Abstract:
BackgroundUser fees have been shown to constitute a major barrier to the utilisation of health-care, particularly in low-income countries such as the Democratic Republic of Congo (DRC). Importantly, such barriers can lead to the exclusion of vulnerable individuals from health-care. In 2008, a donor-funded primary health-care programme began implementing user fee subsidisation in 20 health zones of the DRC. In this study, we quantified the short and long-term effects of this policy on health-care utilisation.MethodsSixteen health zones were included for analysis. Using routinely collected health-care utilisation data before and after policy implementation, interrupted time series regression was applied to quantify the temporal impact of the user fee policy in the studied health zones. Payment of salary supplements to health-care workers and provision of free drugs - the other components of the programme - were controlled for where possible.ResultsFourteen (88%) health zones showed an immediate positive effect in health-care utilisation rates (overall median increase of 19%, interquartile range 11 to 43) one month after the policy was introduced, and the effect was significant in seven zones (P <0.05). This initial effect was sustained or increased at 24 months in five health zones but was only significant in one health zone at P <0.05. Utilisation reduced over time in the remaining health zones (overall median increase of 4%, interquartile range ¿10 to 33). The modelled mean health-care utilisation rate initially increased significantly from 43 consultations/1000 population to 51 consultations/1000 population during the first month following implementation (P <0.01). However, the on-going effect was not significant (P =0.69).ConclusionsOur research brings mixed findings on the effectiveness of user fee subsidisation as a strategy to increase the utilisation of services. Future work should focus on feasibility issues associated with the removal or reduction of user fees and how to sustain its effects on utilisation in the longer term.
Publisher:
BioMed Central
Issue Date:
5-Nov-2014
URI:
http://hdl.handle.net/10144/336619
DOI:
10.1186/s12913-014-0504-6
PubMed ID:
25370385
Language:
en
ISSN:
1472-6963
Appears in Collections:
Operational Research Courses

Full metadata record

DC FieldValue Language
dc.contributor.authorMaini, Ren_GB
dc.contributor.authorVan den Bergh, Ren_GB
dc.contributor.authorvan Griensven, Jen_GB
dc.contributor.authorTayler-Smith, Ken_GB
dc.contributor.authorOusley, Jen_GB
dc.contributor.authorCarter, Den_GB
dc.contributor.authorMhatre, Sen_GB
dc.contributor.authorHo, Len_GB
dc.contributor.authorZachariah, Ren_GB
dc.date.accessioned2014-12-04T16:01:45Z-
dc.date.available2014-12-04T16:01:45Z-
dc.date.issued2014-11-05-
dc.identifier.citationPicking up the bill - improving health-care utilisation in the Democratic Republic of Congo through user fee subsidisation: a before and after study. 2014, 14 (1):504 BMC Health Serv Resen_GB
dc.identifier.issn1472-6963-
dc.identifier.pmid25370385-
dc.identifier.doi10.1186/s12913-014-0504-6-
dc.identifier.urihttp://hdl.handle.net/10144/336619-
dc.description.abstractBackgroundUser fees have been shown to constitute a major barrier to the utilisation of health-care, particularly in low-income countries such as the Democratic Republic of Congo (DRC). Importantly, such barriers can lead to the exclusion of vulnerable individuals from health-care. In 2008, a donor-funded primary health-care programme began implementing user fee subsidisation in 20 health zones of the DRC. In this study, we quantified the short and long-term effects of this policy on health-care utilisation.MethodsSixteen health zones were included for analysis. Using routinely collected health-care utilisation data before and after policy implementation, interrupted time series regression was applied to quantify the temporal impact of the user fee policy in the studied health zones. Payment of salary supplements to health-care workers and provision of free drugs - the other components of the programme - were controlled for where possible.ResultsFourteen (88%) health zones showed an immediate positive effect in health-care utilisation rates (overall median increase of 19%, interquartile range 11 to 43) one month after the policy was introduced, and the effect was significant in seven zones (P <0.05). This initial effect was sustained or increased at 24 months in five health zones but was only significant in one health zone at P <0.05. Utilisation reduced over time in the remaining health zones (overall median increase of 4%, interquartile range ¿10 to 33). The modelled mean health-care utilisation rate initially increased significantly from 43 consultations/1000 population to 51 consultations/1000 population during the first month following implementation (P <0.01). However, the on-going effect was not significant (P =0.69).ConclusionsOur research brings mixed findings on the effectiveness of user fee subsidisation as a strategy to increase the utilisation of services. Future work should focus on feasibility issues associated with the removal or reduction of user fees and how to sustain its effects on utilisation in the longer term.en_GB
dc.languageENG-
dc.language.isoenen
dc.publisherBioMed Centralen_GB
dc.rightsArchived with thanks to BMC Health Services Researchen_GB
dc.titlePicking up the bill - improving health-care utilisation in the Democratic Republic of Congo through user fee subsidisation: a before and after studyen
dc.identifier.journalBMC Health Services Researchen_GB

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